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Celebration Event 21 st October 2014

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Celebration Event 21 st October 2014. Leading Across Boundaries Programme. Welcome. Agenda for today. 10.15 Welcome and Introduction 10:45 Project Presentations x 2 11:15 Break 11.45 Creating sustainable leadership 12.45 Lunch – Market Stalls and Networking 13.45 Project Presentations - PowerPoint PPT Presentation
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Celebration Event 21 st October 2014
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Celebration Event

21st October 2014

Leading Across Boundaries Programme

Welcome

10.15 Welcome and Introduction

10:45 Project Presentations x 2

11:15 Break

11.45 Creating sustainable leadership

12.45 Lunch – Market Stalls and Networking

13.45 Project Presentations

14:15 Awards

14:45 Key Note Speaker – Gavin Boyle, Chairman of

East Midlands Leadership Academy

16.00 Close

Agenda for today

Leading Across Boundaries The Academy has recently joined Twitter we would

like you to “Tweet” to

•Raise and respond to questions

•Provide feedback on speakers comments

•Comment on key topics

•Collaborate & network

Please use the following hash tag #emlaAcrossBoundaries

Follow @nhsEMLA to keep up to date with what’s going on in our region

LEADING ACROSS BOUNDARIES

CELEBRATION EVENT – 21st October 2014

Welcome

Paul O’Neill – Director of East Midlands Leadership Academy

SYSTEMS LEADERSHIP

WHAT IS IT?

#emlaAcrossBoundaries LEADERSHIP WORD 1, WORD 2, WORD 3

#emlaAcrossBoundaries SYSTEM – Definition (about 100 characters)

Good Organisational Leadership:•Single Vision•Aligned Strategy and Business Plan•Focus on Quality and Finance•Strong Governance•Standardised policies and procedures•Agreed measures of success•Owned and Understood Values and beliefs•Consistent and Positive Culture•Distributed Leadership•Strong team identities and effective working

Having all of these traits working well together is not very common in large healthcare organisations.

Consider working with multiple organisations – how many of these are true?

Key findings•Delivering system-level integration will require a combination of a collaborative approach to leadership and directive, effective organisational leaders.

•Both of these different leadership approaches can and ideally should be modelled within the system, but this is challenging at an individual level.

•Health and social care organisations are complex adaptive systems. Successful approaches to developing system leaders recognise this and the need for a new leadership approach, although paradigms of ‘command and control’ leadership are prevalent.

•Studies show that the world’s most successful health care systems make widespread and systematic use of improvement methods. These encourage learning by doing, using small tests of change to observe, reflect and explore what works best for a particular context.

David FillinghamBelinda WeirOctober 2014

Learning in a complex adaptive system

•Learning needs emerge and change

•Inter-organisational and inter-professional teams are critical to successful change

•What works is context specific… so local organisation and health economies will need to adapt not just adopt

•A successful change will require attention to technical aspects (‘the anatomy’) and cultural aspects (‘the physiology’).

•(Zimmerman et al 1998)

Learning from other sectors: markets, hierarchies, networks

Key features Market Hierarchy Network

Normative basis Contracts Employment relationship

Complementary strengths

Means of communication

Prices Routines and rules Relationships

Conflict resolution Haggling/litigation Administrative edict Reciprocity seeking win/win

Commitment among the parties

Low Medium to high High

Tone or climate Suspicion Formal bureaucratic Open-ended mutual benefit

Actions Independent Dependant Interdependent

Source: adapted from Powell (1990)

LEARNING FROM THE PRIVATE SECTOR

•Learn to operate without the might of the hierarchy behind them and use their individual skills rather than their formal position to achieve results

•Be able to compete in a way that enhances rather than undercuts the competition – to do this these leaders must become successful collaborators

•Conduct their business to the highest ethical standards; trust is crucial to successful alliance-building

•Develop a process focus – concentrating not only on what is to be achieved but how

Knowledge and skills framework What skills and knowledge do you need to do this?

Technical know-how • Service design• Governance arrangements• Innovative contracting and financial

mechanisms

Improvement know-how • Systems thinking• Improvement science• Large-scale change

Personal effectiveness • Interpersonal skills and behaviours• Coaching ability• A visionary and participative style

Discuss in Pairs:

•What have you learned that you didn’t know before you did this programme?

•In what ways (if any!) have you changed the way you work with others?

Discuss in Groups:

•How successful has your project been? (score 1-10)

•How much has the learning from this programme contributed to its success? (score 1-10)

•Add these two scores together.

•Make sure everyone on your table knows what your total score is!

Let’s get Curious!

The ability to work across boundaries and to put the needs of the system ahead of, or at

least alongside,those of their own institution will be one of

the hallmarks of the leaders who willthrive in the new world.

Chesterfield Royal Hospital NHS Foundation Trust & Derbyshire Community Health Services NHS Trust

Frail Elderly Care Pathway Part 1 & 2

Integrated Care and the Discharge

to Assess and Manage Process

Integrated care‘The current fragmented services fail to meet the

needs of the population and greater integration can improve the patient experience and the outcomes

and efficiency of care’

(Kings Fund, March 2013)

•The aim for Northern Derbyshire as outlined in our System Plan is to keep people:

• Safe and Healthy – free from crisis and exacerbation

• At home – out of social and health care beds

• Independent – managing with minimum support

Right care, Right place, Right time

Patient centred wrap around care

More efficient with NO duplication

“In a fully integrated system, patients’

needs not organisational

boundaries would decide how care is

provided”Nuffield Trust, 2014

Our LAB team• Ruth Cooper – GP and Integrated Care Lead,

Hardwick CCG

• Kath Shakespeare – Consultant Geriatrician, Chesterfield Royal Hospital (CRH)

• Lisa Falconer – Matron, Acute Frailty Unit, CRH

• Kim Ashall – General Manager, Derbyshire Community Health Services

• Carolyn Nice – Group Manager, Adult Care, Derbyshire County Council

• Kirsty Ball – Senior Commissioning Manager, North Derbyshire CCG

Why are we trying to keep people out of hospital?

10%10%

Frailty Unit Pilot at Chesterfield Royal Hospital

• Unit for the acute care & re-ablement of frail older patients

• MDT working with a patient centred approach & comprehensive geriatric assessment

• Enables timely discharge with coordinated and integrated plan for treatment & follow up

Why D2AM?Thinking about risk differently…

Traditional Discharge ModelMedically ready for

discharge

Therapy assessments

Care needs ascertained

Care package

Discharge

ICT PILOT

• Two pilot sites working with two identified GP practices of a substantial size

• Community based teams of Therapists, Nursing Staff, Social Care and GP support

• Teams supported by the Care Co-ordinators within the two GP practices

The teams

What went well

The teams

Enthusiasm

Permission

Knowle

dge

Process

ImpactCommunicati

on

Even better if…

… we had senior nurse input

… there was one IT system and better network coverage

… we could access equipment more quickly

… we had more patients through the pilot

... we had more comprehensive services out of hours

… the community teams had more experience managing risk

… the pilot was the day job

Next Steps

• Full evaluation

• Rollout from the Frailty Unit

• Roll out across Chesterfield Royal

• Discharge process at out of area acute sites

Questions for the team

Northampton General Hospital

Theatre Improvement

Leading Across Boundaries Programme

Winning Ways

Northampton General Hospital NHS Trust

•Mr Paul Jervis (ENT Consultant)•Dr Ramaswamy Karunakaran (Consultant Anaesthetist)•Mrs Sue McLeod (General Manager) •Mrs Lorna Gould (IQE Advisor)•Mrs Linda Bazeley (Theatre Improvement Project Lead)

Our Great Team

• Lots of different club Chairman

• No one counting the goals

• Couldn’t see the league table

• Lack of investment

• We didn’t hear the whistle

• We didn’t know where the goal was

Our football team, Northampton Town F.C; ‘The Cobblers’ statistics. A tale of woe….

• Exec team and external companies

• Poor data quality

• Theatre Dashboard not being used

• Data analysis / time/ equipment /I.T./ training

• Start and finish times

• No shared vision

More woe….

• No Red Cards

• No set pieces

• No pre-match chat

• No post match celebrations

• No plan for the season

• Behaviours unchallenged

• No standardisation

• Few planning meetings

• Debriefs

• No capacity and demand planning

Our club strategy….

•Player / Manager

•Coaching

•Project team

• Years secondment for Theatre Matron

• EMLA

• Learning new skills

Second half….

•Agree length of match

•Kick off and finish on time

•Improve team play

•Understand the off-side rule!

•Avoid relegation

• Session times, 85% utilisation target

• Improve start and finish times

• Same teams working together

• Greater understanding of business

• Sustainability

Thank you for listening. Any questions?

Leading Across Boundaries Programme

Break

Leading Across Boundaries Programme

Reducing Internal Waits

Royal Derby Hospital

Reducing Internal Waits•Why did we ‘chose’ the project?•Who we are?•What did we expect from ‘Leading Across Boundaries’?

•What did we need to know?•How did we plan to do it?•What did we find?•How did we tackle the problem?•How will we solve the problem?

Why did we do this project?•Acute Trusts have constant pressure from ED 4-hour target

•4-hour target is a whole-system measure

•Inefficient IP processes = Inadequate acute bed capacity = Poor flow = Failed 4-hour target

•Ageing population/Complex co-morbidities

•We need to create capacity within the system

Why did we do this project?

•The Emergency Care Intensive Support Team (ECIST) reviewed all RDH in-patients with a LOS over 7 days in August 2013.

•20% of adult inpatients were only in hospital because they were awaiting a test, specialist opinion or similar

‘We can reduce length of stay for a significant proportion of our adult in-

patients by expediting tests, assessments, specialist opinions or

similar.’

Hypothesis

December 2013: The A teamName Role

Jonathan Allsop 

Associate Medical Director

Chris Whale 

Assistant Clinical Director

Jenny Sidle 

Operations - Head Of Nursing

Penny Owens 

General Manager/Lead Radiographer - Imaging Business Unit

Liz Ryalls 

Transformation Programme Manager

What did we expect from LAB?

What did we need to know?

What do patients wait for?

Why do patients wait?

How did we plan to do it?

It’s not just about the project…..

How did we plan to do it?

How did we plan to do it?

What did we discover?

How did we measure impact?

How did we measure impact?

“No fault found”

Recurring solutions

How will we measure?

How will we measure?

How will we measure?

IT systems don’t work?

IT systems will work

“Ready to Go!”

Thanks to Joanna Klein and Rachel JerramLots of work to do (Phase 2).

Comms, branding, development

Inspired by commitment.

Leadership is a journey.

Traffic jam in the rain

Open road in the sun

Leadership…a resource for the team not a privilege for the incumbent…should be defined and evaluated in terms of the performance of the team

Robert Hogan

Creating sustainable leadership

As a team consider;•How you worked together as a team? What felt easy? What took time to develop?

•Your highs and lows over the last 10months

•What experiences and learning will support you in future Leading Across Boundaries working?

•How will you build on success?

Letters from the Launch EventTake some time to reflect:•What you have learnt about yourself from the programme? •How are you leading differently?•What is your leadership goal for the future?

Leading Across Boundaries Programme

Lunch

Integrated Mental Health Tri-Agency Triage Car

Background East Midlands Ambulance Service cover 6425 square miles across

Lincolnshire, Nottinghamshire, Leicestershire and Rutland, Derbyshire and Northamptonshire.

We serve a population of approximately 4.86 Million people delivering both Emergency and urgent care transport, as well as PTS within the North of Lincolnshire.

On a daily basis EMAS receive 2155 emergency calls via 999.

Ambulance staff nationally receive limited mental health training during their standard paramedic education.

The most probably outcomes for Mental health patients in crisis when seen by EMAS are section 136 and ED attendance.

What is a Tri-Agency Mental Health Triage Car?

A car with the specific function of meeting the needs of those in mental health crisis.

Supported by three agencies, Ambulance, Mental health and Police

Unmarked Car provided by and maintained by EMAS

Trained staff man the car from ambulance and mental health services to ensure a complete Pyscho-Social assessment is completed combining the expertise of the two health professionals

Provides on scene support for Patients, Ambulance staff and Police

Provides telephone triage for Ambulance and Police

Current Operating Procedure All call outs are processed through the Lincolnshire Emergency operations

centre for EMAS.

The car is staffed from 16:00 to 00:00 seven days a week and is accessible by EMAS frontline staff and police

Police calls and 999 calls are processed through AMPDS(Card 25)

EMAS frontline staff call control for support the car then attends to provide back up.

 The car provides assessment and intervention as required and a care plan is agreed on by the paramedic and mental health nurse.

 If a police officer is present at the call then the care plan is tri-agency with agreement from the police officer as well.

Care plans will be created with, and provided to the patient if appropriate.

ImpactPre-car Outcomes Current Outcomes

Who Benefits From This Outcome? Improved outcomes for patients who are detained in the community.

Reduction in ambulance crews and police on scene time

Reduction in the use of conveyance by police and ambulance crews.

Reduction in the number of inappropriate detentions made under the s136 of Mental Health Act.

Reduction in the call out of Forensic Medical Examiner (FME) and Approved Mental Health Professional (AMHP) within custody.

Increased accessibility to mental health service staff beyond normal working hours.

Experimental learning due to multi agency teamwork, leading to greater understanding of roles of other professionals within the mental health service.

Improved use of resources and multiagency working leading to financial benefit for the National Health Service and the Criminal Justice System.

EVERYONE!

Where Do We Go From Here? Review the hours the Lincoln Car runs

Review the need for a second car

Consider expanding the role of the car to include adolescents

Integrate the car across EMAS to improve patient services across the trust

Develop a paramedic rotation to combine time on the MH car and standard responding.

Up-skill the Paramedics to include suturing/gluing

Expand the paramedics Mental Health knowledge and skills

Use the links developed with Mental Health services to create pathways for Paramedics when the car is unavailable

Rampton Hosptial, Nottinghamshire Healthcare NHS Trust

Women’s High Secure Physical Healthcare

The Jasmine Healthcare Suite for Women in a High Secure

Psychiatric Setting

Dr Sue Elcock (Consultant Forensic Psychiatrist)Mr Richard Phipps (General Manager)

Ms Natalie Jennings (Modern Matron, Forensic Division)Ms Martina Griffiths (Ward Manager – Topaz Ward)

Ms K Johnstone (Team Leader – Topaz Ward)

CLINICAL NEED

To develop a therapeutically appropriate and safe environment for patients to receive physical healthcare whilst maintaining privacy and dignity e.g. palliative care

To provide an enhanced level of staff knowledge and confidence in identifying and managing physical health issues in patients in a psychiatric setting

To be able to maintain ongoing psychiatric care whilst receiving appropriate physical healthcare in their own environment to aid relational security and reduce risks potentially associated with inpatient admissions to other hospitals

To provide equivalent care to female patients as male patients

AIMS

IMPACT “Whilst being nursed in the jasmine suite I felt all my needs were met and I

felt I could move around without being restricted. I had lots of amenities at hand and the staff were brilliant. I had more quality of life on the jasmine suite than I’ve ever had being nursed out of grounds. My transition from Bassetlaw to the Jasmine Suite went very smoothly and there was nothing more I could of needed. Once in the Jasmine Suite I was able to move around more freely and was able to reach all of the amenities without much assistance. The fresh air and exercise are easily accessible and wheelchair access is well within limits. I think fresh air is an important part of recovery. The actual suite is well ventilated, cosy and warm, its homely and pleasant, staff were friendly and its very spacious. I feel the Jasmine Suite is well equipped and all the amenities are well at hand for the patient. The Jasmine suite played a very big role in my transition back to the ward and I hope all other people that stay there will be comfortable too.”

“I was very privileged to be part of the opening of the Jasmine Suite but I was personally proud of the fact that after the death of a friend I had written to Dr H suggesting that we needed an infirmary suite that catered for palliative care as well as convalesce where recovery can be physical as well as mental. It was named by a patient who won a prize for naming it in a competition and has been used already for a patient to recover after a hospital stay.”

THE FUTURE

Awards

Leading Across Boundaries Programme

Coffee

Gavin Boyle,

Chief Executive Officer, Chesterfield Royal Hospital NHS Foundation Trust & Chairman East Midlands Leadership Academy &

Leading Across Boundaries Programme

Close

Some simple maths

17+85+6+58+ 85 = LAB


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